The Indian Health Service’s electronic health records system is getting an upgrade. And it’s following the same joint EHR plan as the Department of Veterans Affairs and the Defense Department.

“The IHS has had a very long collaborative process with the Veterans Administration,” said Howard Hays, the acting chief information officer of IHS, on Federal News Radio’s Agency of the Month show. “Our health information system at IHS is in large part based on the VA’s system. We’ve been very fortunate over the years to leverage the VA development in the VistA system to provide the core functionality for [our resource patient management system] (RPMS).”

The Indian Health Service will appropriate the tools used by the VA to apply to its RPMS throughout the country. The trick is finding the resources and applying those best practices to federal offices that sometimes aren’t equipped with modern Internet access.

An agency of extreme demands

IHS is a unique agency within the Department of Health and Human Services. Providing health care services to American Indian tribes and Native Alaskan populations, the IHS is an agency caught between two extremes.

“[It’s] a fairly small agency within the HHS, about a $5 billion annual budget,” said Hays. “And it’s the only HHS agency to provide direct health care services on a wide scale.”

That includes health care facilities across 35 states. IHS manages 45 agency-run tribal and federal hospitals, and several hundred clinics. Those range in type from large mutli-specialty clinics to small Alaskan village clinics.

“We’re very widely distributed, we’re very rural, and we have a population that has a lot of health challenges,” said Hays. “We have an important mission to improve health care and delivering that mission across the entire country, basically on a very modest budget, is a significant challenge.”

Those challenges make the technology infrastructure of IHS inconsistent across the country. When it comes to electronic health records, many offices and clinics still run on a T1 Internet service platform. A T1 line is one of the lowest tier commercial Internet lines. Most large organizations use much faster fiber optic cables.

“The IHS electronic health system is, at present, a locally deployed client-server type of application,” said Hays. “It’s difficult to get beyond that in some of these places because if you try to have an externally hosted solution you’re not going to have the connectivity to allow it to stay up and stay reliable.”

This means IHS has difficulty implementing the health IT standards passed down by HHS and other departments. Their challenges are unique depending on where offices and clinics are located, the technology patients have access to and, simply, the money allocated to the agency.

Because the IHS works intimately with non-federal organizations (tribal organizations, local communities, etc.), the agency has to weigh federal requirements for online privacy with what’s available from outside partners. The agency runs on a federal Wide Area Network (WAN), and often supports tribal communities and helps them adhere to federal privacy standards.

“We continue to enforce policies as well as software development best practices to ensure that the records are safe,” said Hays. Like any medical facility, IHS has policies that apply all the way down to the user level.

Even as the federal government continues to develop the nationwide Health Information Network, privacy and policy requirements will be incorporated into the IHS model.

“We have to apply to the policies and protocols of those systems as well,” said Hays. “And we do. We know what we need to be doing and we enforce it.”